CLINICAL RESEARCH: CARDIAC IMAGING
Noninvasive Myocardial Strain Measurement by Speckle Tracking Echocardiography
Validation Against Sonomicrometry and Tagged Magnetic Resonance Imaging
Brage H. Amundsen, MD*,1,*,
Thomas Helle-Valle, MD ,2,
Thor Edvardsen, PhD, MD,
Hans Torp, DrTechn*,3,
Jonas Crosby, MSc*,1,
Erik Lyseggen, MD,2,
Asbjørn Støylen, MD, PhD*, ,
Halfdan Ihlen, MD, PhD,
João A.C. Lima, MD, FACC ,
Otto A. Smiseth, MD, PhD, FACC and
Stig A. Slørdahl, MD, PhD*,
* Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
Institute for Surgical Research/Department of Cardiology, Rikshospitalet University Hospital, Oslo, Norway
Department of Cardiology, St. Olavs Hospital/Trondheim University Hospital, Trondheim, Norway
Department of Cardiology, Johns Hopkins University, Baltimore, Maryland.
Manuscript received April 15, 2005;
revised manuscript received August 14, 2005,
accepted October 3, 2005.
* Reprint requests and correspondence: Dr. Brage H. Amundsen, Department of Circulation and Medical Imaging, NTNU, MTFS, N-7489 Trondheim, Norway. (Email: brage.h.amundsen{at}ntnu.no).
OBJECTIVES: The aim of this study was to validate speckle tracking echocardiography (STE) as a method for angle-independent measurement of regional myocardial strain, using sonomicrometry and magnetic resonance imaging (MRI) tagging as reference methods.
BACKGROUND: Tissue Doppler imaging allows non-invasive measurement of myocardial strain in the left ventricle (LV), but is limited by angle dependency.
METHODS: Strain measurements with STE were obtained by a custom-made program that allowed tracking of two-dimensional motion of speckle patterns in a B-mode image. In anesthetized dogs, we compared LV long- and short-axis measurements by STE to sonomicrometry during preload changes and regional myocardial ischemia. Measurements in the two orthogonal axes were obtained simultaneously in a single imaging plane. In human subjects, long-axis strain by STE and MRI tagging were compared in multiple segments of the LV.
RESULTS: In the experimental study there was good correlation and agreement between STE and sonomicrometry for systolic strain in the long axis (r = 0.90, p < 0.001; 95% limits of agreement –4.4% to 5.0%) and systolic shortening in the short axis (r = 0.79, p < 0.001; –5.6% to 5.1%). In the clinical study, 80% of the segments could be analyzed, and correlation and agreement between STE and MRI tagging were good (r = 0.87, p < 0.001; –9.1% to 8.0%).
CONCLUSIONS: Speckle tracking echocardiography provides accurate and angle-independent measurements of LV dimensions and strains and has potential to become a clinical bedside tool for quantifying myocardial strain.
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Abbreviations and Acronyms
| | COR = coefficient of repeatability | | LAD = left anterior descending artery | | LV = left ventricle/ventricular | | MRI = magnetic resonance imaging | | ROI = region of interest | | STE = speckle tracking echocardiography | | TDI = tissue Doppler imaging |
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